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PLEASE READ 

If you do not see a confirmation page immediately after submission, do not close your window - application has not been received.

CLIENT APPLICATION FOR SUPPORT

Max's Can Only Provide Support for Owners who have proof of residency in Monterey County.

YOU MUST BE A RESIDENT OF MONTEREY COUNTY TO BE CONSIDERED FOR FINANCIAL ASSISTANCE. WE ASSIST LOW TO ZERO INCOME FAMILIES, PLEASE CONSIDER THIS BEFORE APPLYING. WE CAN NOT ASSIST WITH BILLS ALREADY PAID TO AN ANIMAL CLINIC.

Please note we are only able to assist responsible pet owners who current have low to zero income.
If you are requesting more than $750, additional steps may be required.

PET INFORMATION


We are only able to assist with dogs/cats.

Provide as much detail as possible such as how this illness or injury occurred and why you are applying for assistance. Incomplete information may delay processing.


(If you do not have a primary care veterinarian, explain why not here.)





PET OWNER & SPOUSE/PARTNER/PET CO-OWNER INFORMATION



*






Attach documentation OR send be email after submission. Application will be expedited once documentation is received.

HOUSEHOLD FINANCIAL INFORMATION

ie CalWorks/CalFresh, CalWater (LIRA),PG&E (REACH)/PG&E (CARE),(CHIP), Social Security (SSI) or (SSP), AT&T Lifeline, HHS (HEAP), CHISPA, Medi-Cal for Aged and Disabled Covered California Silver Government Programs.

IF YOU HAVE ANSWERED YES TO THE ABOVE, PROOF OF CURRENT ENROLLMENT IS REQUIRED TO SEND. PLEASE INCLUDE IT IN YOUR APPLICATION TO EXPEDITE YOUR APPLICATION PROCESS.

NOTE: Proof of Low-Income Assistance Program or Care Credit Application Results are required for requests over $750. Response from Care Credit is immediate. (www.carecredit.com)






DOCUMENTATION/APPLICATION SUPPORT - REQUIRED (ID, PROOF OF FINANCIAL NEED, PET PHOTO) 


Ideally LANDSCAPE Orientation (Camera turned on side)

Ideally LANDSCAPE Orientation (Camera turned on side)


Can be Paystub, Employer Letter, Tax Return Page, other.




Please check all boxes.

Once you press SUBMIT.. if a confirmation page does not show, please scroll up to see fields marked in red that require additional attention.